The humanitarian battle in Iraq

The humanitarian battle in Iraq

Theme: The topic of this analysis is Iraq’s deteriorating humanitarian conditions. The analysis assesses the incident of excess deaths in the post Gulf War period, and the causes for regional differences in child mortality resulting from Iraq’s interior policy.

Summary: The recent debate over war or no war in Iraq has focused on the humanitarian aspects, and the additional human hardship of a possible intervention. The main argument is: forcing Iraq to disarm using military force over available peaceful means would worsen the conditions for the already suffering Iraqi people, and tens of thousand innocent people would die. This analysis aims at clarifying the Iraqi people’s current situation.  While it was a high-risk enterprise, the Gulf War has proven less lethal for Iraq’s population than the peaceful resolutions UN has been enforcing since the cease-fire. The analysis assesses the reason for this unfortunate development, and tries to establish in what way the peace agreement backfired. The analysis suggests that the International Community has reached a point where it face no other alternative than to set a time limit for its current choice of policy.



The Gulf War did not end in the same way as for example the Second World War when the allied troops forced a total capitulation, and disposed what was left of an already dissolving enemy administration. The Gulf War ended as a result of a cease-fire, followed by a peace agreement, stipulating hard but not unreasonable conditions in exchange for not finalizing the invasion and replace Saddam Hussein.

To avoid total capitulation, the government in Baghdad agreed under UN security council resolution 687 to “…unconditionally accept, under international supervision, the destruction, removal or rendering harmless of its weapons of mass destruction, ballistic missiles with a range over 150 kilometres, and related production facilities and equipment…”. Furthermore, to maintain a high level of pressure on the Iraqi government and ensure a swift implementation of Resolution 687, the Security Council reaffirmed the economic sanctions imposed on Iraq on August 6, 1990, in response to Iraq’s invasion of Kuwait (see Resolution 661). Thus, Iraq was only allowed to import foodstuffs, medicine and health supplies at the end of the war. This embargo would be lifted as soon as UN’s weapon inspectors had verified the completion of Iraq’s disarmament.

The United Nations Security Council’s Observation Mission (UNSCOM) and the International Atomic Energy Agency’s (IAEA) conducted weapon inspections from April 3, 1991 until October 31, 1998, when Iraq announced unilaterally that it would halt UNSCOM’s activities inside Iraq. UN subsequently replaced UNSCOM with the United Nations Monitoring Verification and Inspection Commission (UNIMOVIC), and resumed weapon inspections in Iraq in November 2003 (see Resolution 1441). In retrospect, the weapon inspections turned out to be like opening a can of worms. Iraq proved to possess far more lethal capacity than anyone could have imagined. They intentionally concealed its arms possession from the inspectors, and they refrained from cooperation with them. (See UNSCOM: chronology of events and Resolution 707). Several incidents during the period 1991 to 1998 support the notion that Iraq, instead of disarming, actually intended to continue developing its weapons of mass destruction program, and to obtain nuclear capacity. UNSCOM was unable to verify that Iraq had disposed of all its weapons of mass destruction. The resumed inspections regulated by Resolution 1441 have made partial progress but under the massive military threat and concentration of UK and US troops on Iraq’s boarders. Unconditional cooperation is still lacking, and it is uncertain if UNIMOVIC will be able to finish what UNSCOM started.

Since UNSCOM was unable to verify that Iraq had disarmed, the International Community never lifted its economic sanctions. The prolonged weapon inspections have forced the UN to review the mechanisms governing the sanctions out of concern for the imminent risk of deteriorating nutritional and medical situation in Iraq. Unfortunately, Baghdad has not cooperated with the Security Council in providing basic needs to the population. Baghdad rejected the early Oil for Food program in 1991, which would have allowed Iraq to sell oil in exchange for foodstuffs, medicine, and health supplies under UN’s control (see resolution 706).  Still failing to comply with its obligation to disarm, in August 1996 Iraq accepted the revised Oil for Food program (see Resolution 986, first shipment of goods began in 1997).

In addition to its attempt to provide Iraq with foodstuffs and medical supplies through the Oil for Food program, the Security Council insisted that “Iraq allow immediate access by International humanitarian organizations to all those in need of assistance in all parts of Iraq and make available all necessary facilities for their operations” (see Resolution 688 from April 5, 1991). As with weapon inspections and Oil for Food, Iraq did not cooperate on this issue either. Humanitarian aid organizations and aid workers have not been able to move freely inside Iraq, nor have they been assigned government escorts to enable humanitarian inspections inside the country. However, Saddam’s withdrawal of troops from the three northern districts in 1991, made the north an open territory for international humanitarian organizations. The different attitude towards international aid in northern Iraq and in central/southern Iraq is evident considering that there are 34 humanitarian organizations operating in the three northern districts and 11 in the central/southern districts (see Mohamed and Shah “Sanctions and Child mortality in Iraq” 2000). It is worth noticing that northern Iraq is placed under a double embargo, both by Iraq and the UN since 1991.

In 1991, most parameters were in place for what looked like a fast track back to normality. Iraq, after having fulfilled its obligations under resolution 687, could look forward to UN lifting the embargo, resume trade, and start the reconstruction of the country. However, it is safe to say that the International Community’s peace plan backfired.

The Peace Agreement that Backfired

To what extent has the post Gulf War period affected the welfare of the Iraqi people? As one could expect, the economic sanctions have isolated Iraq from the rest of the world in economic terms. The country’s GDP per capita has plunged from 3.500 USD in 1990 to hit a bottom of 540 USD in 1996. After 1996, when the revised Oil for Food program started, economic conditions are slowly improving. GDP is back up at around 1.500 USD. While GDP is a blunt indicator for individual welfare situations, it captures deprivation well, and is a good approximation of worsened economic conditions. Hence, judging by the GDP development between 1991 and 1996, the period in which Saddam refused any cooperation with the International Community, the Iraqi people’s capacity to buy food and other goods almost vanished.

The other obstacle for welfare is of course the lack of commodities. Iraq relied heavily on import of food and medicine before the Gulf War and it still does. Until the Oil for Food program started to bring commodities into the country, import of medicine has been almost negligible. For example, between 1991 and 1993 humanitarian organizations imported 5% and the government bought another 10% of the country’s pre-war levels of foodstuffs and medical supply. So, even if people had money there were simply no goods available between 1991 and 1996.

The worsening conditions between 1991 and 1996 have been lethal for the Iraqis. The incident of malnutrition and infectious diseases has escalated. The lack of cash and the almost total stop in imports made reconstruction and maintenance of infrastructure slow down or stop. Potable water has become a rare commodity. The question is how bad is the humanitarian situation in Iraq?

The perhaps best way to assess the effects of deteriorating living conditions is by analysing a country’s mortality trends, and more specifically, its infant and child mortality rates. Children are the most vulnerable group in society. Malnutrition and lack of medical care have fatal consequences for children, and mortality trends for this group is considered a reliable measure for a country’s development. In addition, the problems causing changes in child mortality levels affect the population at large. Thus, high infant and child mortality is in most instances proof of a more serious situation.

Figure 1 compares temporal differences in infant mortality (children under age 1) in Iraq and all its neighbouring countries. Figure 2 makes the same comparison for child mortality (children under age 5). Both Figures show a general trend. Between 1960 and 1990, mortality rates fell in all countries in the region. Large differences between countries are evident. Kuwait, Jordan, Iraq, and to some extent Syria stand out with the lowest rates, indicating advanced development in these countries. Country differences have decreased over time in absolute numbers. With the exception of Iraq, all countries in the region have an infant mortality rate under 40 (per 1000 children), and a child mortality rate under 50 (per 1000 children).

The most stunning evidence to be drawn from Figures 1 and 2 is not the region’s declining mortality among children, but the remarkable increase in infant and child mortality rates for Iraq. In 1990, prior to the Gulf War, infant and child mortality rates in Iraq were among the regions lowest, (40 and 50 dead per 1000 children respectively). In 2000, both rates had increased by more than 250%, reaching a level of 105 and 130 dead per 1000 children respectively. Child mortality in Iraq is back at the levels registered in the early 1960s – an unparalleled stagnation and regress of development.

Richard Garfield, in his report “Morbidity and mortality among Iraqi children” (1999), estimates that the excess mortality in Iraq between August 1991 and March 1998 is likely to be as high as 227.000 dead children. (This corresponds to an average of 60 excess deaths per day for the period). To put these numbers into perspective: The US Census Bureau estimates that 5000 civilians were killed during the Gulf War, the Iraq government reported 2278 civilian deaths. The US census bureau’s number is regarded as the most reliable. Unconfirmed total death toll among Iraqi soldiers oscillates between 50 and 65 thousand. Some sources indicate that as few as 1.000 civilians and 10.000 soldiers were killed (Garfield 1999).

In 1999, UNICEF conducted a large survey to measure child mortality in Iraq. The result of the survey has been subject to ample debate since it revealed large regional differences in child mortality between the three northern semi autonomous regions and central and southern Iraq. Figure 3 is a graphical representation of the UNICEF findings.

Figure 3 shows that, while child mortality increased drastically in Southern and Central Iraq, it has reached historical lows in the three northern districts. This relationship has wrongly been used to support the view that Saddam is not using the resources from the 1996 Oil for Food program to the benefit of his people. While this cannot be excluded, such allegations cannot be assessed with certainty using UNICEF’s statistics. UNICEF measures primarily deaths occurring before March 1997, when the first deliveries from the Oil for Food program finally arrived.

This does not mean that Saddam is not to blame for the development shown in Figure 3. The situation is bad enough anyway. Knowing that Saddam refused international aid and the assistance from aid workers between 1991 and 1996 in the part of Iraq under his direct control. A more credible interpretation of UNICEF’s findings is that UNICEF’s data reveal how the development in South and Central Iraq could have looked like, had Saddam not chosen to refuse the Security Council’s proposals for humanitarian aid as consistently as he did.

While humanitarian aid to central and southern Iraq has been almost non-existent until after March 1997, northern Iraq has been able to receive ample aid since 1991. This aid, which corresponds to 2/3 of the total aid received by Iraq, has cushioned the drought in imports caused by Saddam’s refusal to accept the early Oil for Food program offered in 1991.  In addition northern Iraq has been open territory to international aid organizations and aid workers as intended by UN’s resolution 688 from April 5, 1991. This is not the case in Saddam’s part of Iraq.

Most of the reliable and available data on child mortality concerns the period before 1998. Thus, it is difficult to assess the development after 1998. Reports from inside Iraq indicate that there has been a substantial improvement in the Iraqi’s living conditions as a result of the Oil for Food program. Iraq now exports oil close to pre war levels in exchange for foodstuffs and medical supply. It can be expected that this improvement has stopped further deterioration and stopped mortality rates from increasing. Whether child mortality is decreasing is too soon to tell since the conditions are very far from being satisfactory. Food rations are still regarded as insufficient. Maintenance of water and electrical supply facilities is lagging behind, so is maintenance of health care facilities.

The question is not so much whether Saddam Hussein or the UN has caused Iraq’s explosive increase in child mortality. Both Saddam and the UN are ultimately responsible for this development.

Saddam is clearly the instigator. Not only did he attack and invade Kuwait, he has subsequently opposed all peaceful solutions to end the conflict offered by the UN. He has not respected the cease-fire agreement to unconditionally disarm, thereby prolonging the UN embargo. He refused the 1991 Oil for Food program and exposed his people to the full humanitarian consequences of the worlds, to this date, most effective economic embargo to date. He has intentionally delayed and obstructed the work of international aid and aid work in the government-controlled areas of Iraq. In addition, he has used his scarce available resources to re-build his military capacity, construct palaces, and monuments. By denying the Iraqi people access to basic humanitarian needs offered by the International Community, he has single-handedly thrown his own people decades back in time in terms of progress and development. (See the Human Rights Watch)

The International Community’s blame is different and more complex to assess. UN has opted for peaceful measures in disarming Iraq. However, these measures have proved to be largely ineffective. The Iraq government has shown little or no intent in making the interest of its population its first priority. Furthermore, there is no evidence available that would indicate that Saddam is willing to change. The devastating humanitarian consequences are no recent surprise. They have been relatively well documented since the end of the armed conflict in 1991. It has now past 13 years since the sanctions were initiated, and they are still in place. One would expect more decisive ways in dealing with the obstinacy of the Iraq regime from an international body with human rights as their main guiding principle.

A more relevant question is: whether the humanitarian catastrophe could have been avoided under UN’s sanctions? UNICEF’s surveys on child mortality give some general directions for answering this question. The more favourable mortality development in northern Iraq compared to central and southern Iraq is evidence of how sanctions ought to affect a country’s development. That is, while being a severe punishment, it should at the very least not increase human suffering. The relatively constant child mortality level in northern Iraq is consistent with this view, and is an indication, not of prosperity, but of a temporary status quo that in the absence of sanctions, most likely, would have declined as indicated by the pre war trend. However, in southern and central Iraq, evidence is clear. Human suffering is increasing. It is difficult to imagine that south and central Iraq would have faced the same development if humanitarian aid and aid workers had been welcomed when the UN first offered it. It is even more difficult to imagine that the deteriorating social conditions in this part of the country would be anyway near current levels if the Iraq government had accepted the Oil for Food program in 1991. Northern Iraq is not excluded from the sanctions; on the contrary it is subject to a double embargo. Hence, the development in northern Iraq offers an example of how a different choice of policy on behalf of Saddam could have avoided the humanitarian catastrophe between 1991 and 1996.

Conclusion: A humanitarian catastrophe is probably the best way to summarize the situation in Iraq between 1990 and 1997. The Iraq regime’s willingness to sacrifice its own people to defend its policies is, if not unprecedented, disqualifying their credibility and their legitimacy. The latest reliable estimates indicate that the total excess death, only among children, could be as high as 350.000. This is more than five times the death toll in the Gulf War. Thus, peaceful solutions come at a high price in Iraq. Restoring social conditions back to pre-war levels will probably take a decade if the ideal conditions are in place. However, given the Iraq regime’s track record in cooperation it is not very realistic to think that the UN will achieve disarmament using indirect pressure through sanctions.

Looking back at the chain of events following the Gulf War, it is tempting to believe that had the allied forces completed the invasion and replaced Saddam, the Iraqi people’s suffering would never have reached current levels. This is not an option, however. Instead, the question we have to ask ourselves now is: if the International Community really wants to disarm Iraq, how should this be achieved?

From a humanitarian perspective there is only one available alternative. The only feasible way is to lift the sanctions and open up the country for trade in the shortest possible time frame. This means that if the International Community chooses to maintain its demand for unconditional disarmament before it lifts the sanctions, it has to impose a reasonable deadline for this. Failing to do so calls for a different choice of policy and a different set of mechanisms for disarming Iraq.

Rickard Sandell
Senior Analyst
Demography and Migration

Rickard Sandell

Written by Rickard Sandell